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Combining two strategies to improve perfusion and drug delivery in solid tumors
Open accessAbstract
Blood perfusion in tumors can be significantly lower than that in the surrounding normal tissue owing to the leakiness and/or compression of tumor blood vessels. Impaired perfusion reduces oxygen supply and results in a hypoxic microenvironment. Hypoxia promotes tumor progression and immunosuppression, and enhances the invasive and metastatic potential of cancer cells. Furthermore, poor perfusion lowers the delivery of systemically administered drugs. Therapeutic strategies to improve perfusion include reduction in vascular permeability by vascular normalization and vascular decompression by alleviating physical forces (solid stress) inside tumors. Both strategies have shown promise, but guidelines on how to use these strategies optimally are lacking. To this end, we developed a mathematical model to guide the optimal use of these strategies. The model accounts for vascular, transvascular, and interstitial fluid and drug transport as well as the diameter and permeability of tumor vessels. Model simulations reveal an optimal perfusion region when vessels are uncompressed, but not very leaky. Within this region, intratumoral distribution of drugs is optimized, particularly for drugs 10 nm in diameter or smaller and of low binding affinity. Therefore, treatments should modify vessel diameter and/or permeability such that perfusion is optimal. Vascular normalization is more effective for hyperpermeable but largely uncompressed vessels (e.g., glioblastomas), whereas solid stress alleviation is more beneficial for compressed but less-permeable vessels (e.g., pancreatic ductal adenocarcinomas). In the case of tumors with hyperpermeable and compressed vessels (e.g., subset of mammary carcinomas), the two strategies need to be combined for improved treatment outcomes.
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“Fibrinolytic therapy helps in dissolving fibrins in occluded vessels and improving the tumor vasculature [32,33,34,35,36].”
From Approaches to Improve EPR-Based Drug Delivery for Cancer Therapy and Diagnosis (2023) · cites this paper as [36]
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Metadata
- Authors
- Stylianopoulos, T., & Jain, R. K.
- Affiliations
- University of Cyprus (CY)
- Harvard University (US)
- Venue
- Proceedings of the National Academy of Sciences
- Publisher
- National Academy of Sciences
- Published
- 2013-10-28
- Volume
- 110
- Issue
- 46
- Pages
- 18632-18637
- ISSN
- 0027-8424 (ISSN-L)
- 1091-6490
- PMC
- PMC3832007
- OpenAlex
- W1964128680
- Cited by
- 508
- References
- 67
- Citations by year
- 2026: 49 · 2025: 46 · 2024: 45 · 2023: 47 · 2022: 29 · 2021: 35 · 2020: 53 · 2019: 29 · 2018: 39 · 2017: 35 · 2016: 34 · 2015: 47 · 2014: 19 · 2013: 1
- FWCI
- 34.83
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Licence
- other-oa
- Locations
- Proceedings of the National Academy of Sciences (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (R01CA115767, T32CA073479, R01CA085140, R01CA096915, P01CA080124, R01CA126642, R01CA098706)
- Topics
- Physical Sciences › Mathematics › Modeling and Simulation › Mathematical Biology Tumor Growth
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Angiogenesis and VEGF in Cancer
- Health Sciences › Medicine › Oncology › Cancer Cells and Metastasis
- Keywords
- tumor perfusion, drug delivery, solid tumors, vascular normalization, solid stress, tumor hypoxia, vascular permeability, interstitial fluid flow, mathematical model, drug distribution, glioblastoma, pancreatic ductal adenocarcinoma, breast cancer
- MeSH terms
- Biomechanical Phenomena, Capillary Permeability, Computer Simulation, Humans, Models, Biological, Neoplasms, Regional Blood Flow, Drug Delivery Systems
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